“Every West Virginian deserves access to quality and affordable health care.”

Sen. Joe Manchin said that once.

And yet, last week, the Democrat from West Virginia basically told more than a half-million low-income West Virginians who rely on the federal Medicaid program that they aren’t entitled to the full range of health-care services—only the services that he likes.

And since he doesn’t like abortion—just like the other politicians who have a stranglehold on the reproductive autonomy of people in the United States—that means most poor people in West Virginia will continue to be unable to pay for an abortion thanks to the Hyde Amendment, which is a legislative rider that Illinois Republican Henry Hyde first tacked onto Congress’ annual Health and Human Services spending bill in 1976. The rider excludes abortion from the health-care coverage available to low-income people through Medicaid and was intended to keep poor women from obtaining abortions because those were the only people reliant upon the government for health care.

“I certainly would like to prevent, if I could legally, anybody having an abortion—a rich woman, a middle-class woman, or a poor woman,” Hyde said during congressional debate over the bill in 1977. “Unfortunately, the only vehicle available is the … Medicaid bill.”

At first, the amendment banned abortion coverage only under Medicaid. But over the years, it was expanded and other similar bans were enacted to cover almost every person who relies on the government for insurance coverage.

If you rely on the government for your health-care needs—if you’re in the military or the Peace Corps, if you use Indian Health Service, if you work for the federal government, if you’re in federal prison, or if you are on Medicaid or Medicare—then the Hyde Amendment, or other restrictions it inspired, likely prohibit you from getting an abortion unless you can pay for it yourself. (The government will cover your abortion if the pregnancy is a result of rape or incest, or if carrying the pregnancy to term endangers your life.)

And that’s how it has been for more than 40 years: Republicans—with scant protest from Democrats—have been deciding which pregnant patients get to have abortion care and which don’t, based solely on how much money those patients have and how they’re insured. If that sounds discriminatory to you, that’s because it is.

This year, however, Biden submitted a $6 trillion proposed budget that excludes the Hyde Amendment, making good on a promise that he made to abortion rights activists during his presidential campaign.

But not if Manchin has anything to say about it. Manchin sits on the Senate Appropriations Committee and has the power to block any budget that does not include the Hyde Amendment. And considering that last week he said, “I’m going to support Hyde in every way possible,” it looks like poor people are going to continue to be unable to access the full range of health-care services that should be available through the Medicaid program.

The problem, of course, is that Joe Manchin doesn’t think abortion is health care. If he did, it would be readily apparent to him that withholding health care from people is not only senseless but inhumane.

He’s only withholding health care from poor people, though. Abortion will always be available for people who can pay for it. Rich or middle-class people—any people with means, really—will almost always be able to get an abortion in a pinch if they need one. Even if they live in a state hostile to abortion, they can simply travel to a more abortion-friendly state.

But poor people don’t have this luxury. Denying them insurance coverage under the Medicaid program forces already struggling people to scrape together anywhere from $500 to $1,600 for a first-trimester abortion, a tidy sum that many won’t be able to afford. Later abortions can be as much as $8,000 to $15,000. And as a person desperately tries to come up with the money to pay for an abortion, their pregnancy progresses right along, which can increase the price of the abortion until the person is priced out entirely. A 2009 study found that 1 in 4 women who would have had Medicaid-funded abortions were forced to carry an unwanted pregnancy to term because of the cost.

Unfortunately, Joe Manchin doesn’t care. If you happen to be poor, well that’s just too bad—have another kid and become even more poor. Studies show that’s what happens, which isn’t all that surprising.

After all, if a person cannot scrape together the money to get an abortion, how are they suppose to scrape together the nearly 13,000 a year that it takes to raise a child for 18 years? Especially when anti-choice politicians take a very hands-off approach after a child is born, often demonizing poor mothers—who tend to be Black or brown—for having a kid they couldn’t afford but that the government forced them to have. It’s a cruel irony that plays out on the pregnant bodies of poor people.

Joke’s on you, impoverished West Virginians.

It’s not easy to get an abortion in West Virginia. West Virginia is home to Dr. Byron Calhoun, a virulently anti-choice OB-GYN who encouraged a young West Virginian woman to sue her abortion provider based on the false claim that he had found a 13-week-old fetal skull remaining in her uterus—something the pathology report confirmed was a lie.

In 2017, the Kanawha Surgicenter closed, leaving West Virginia with only one clinic providing abortion care. At the time, Margaret Chapman Pomponio, the executive director of reproductive rights advocacy group WV Free, told Rewire News Group that “rural women, women of color, low-income women will be disproportionately affected [by] the closure of the clinic.”

“It means that getting by day-to-day for marginalized women just got harder in West Virginia.”

Notably, West Virginia has one of the country’s highest poverty rates. Over 16 percent of the state’s residents live in poverty compared to 12.3 percent nationally, according to 2019 statistics compiled by the U.S. Department of Agriculture’s Economic Research Service.

Manchin is not interested in making it any easier for poor people to access reproductive health care. He has routinely sided with Republicans on abortion rights. In 2015, after the scandal regarding Planned Parenthood’s involvement in (perfectly legal) fetal tissue donation erupted, Manchin sided with Republican efforts to defund Planned Parenthood. (Planned Parenthood has been cleared of wrongdoing with respect to the Center for Medical Progress’ claims that the reproductive rights organization was involved in trafficking fetal tissue). And in 2018, Manchin voted for an unconstitutional Trump-backed 20-week abortion ban.

It’s no surprise, therefore, that Manchin has vowed to support Hyde.

With Democrats like these, who needs Republicans?